Diagnosis is established after thorough clinical examination and video Laryngoscopy with biopsy. The other test which can be done are CT Scan, MRI or PET Scan to know the extent of the disease.

Staging

Staging is the process of finding out how far the cancer has spread. This is very important because the type of treatment and the outlook for recovery depends on the stage of the cancer.

The staging system most often used for laryngeal cancer is the TNM staging system, also known as the American Joint Committee on Cancer (AJCC) system.

This system gives three key pieces of information:

• T stands for tumor (how far it has spread within the larynx or hypopharynx and to nearby tissues)
• N describes whether the cancer has spread to lymph nodes
• M stands for spread (metastasis) to distant organs

All this information is combined to arrive at a stage. After stage 0 (which is carcinoma in situ or cancer that has not grown beyond the lining layer of cells), stages are labeled using Roman numerals from I through IV (1-4). The smaller the number, the less the cancer has spread. A higher number, for example, stage IV, means a more serious stage of the disease.

For early stage laryngeal cancers (stages I-II), patients respond equally well to surgery or radiation treatment. For intermediate stage cancers (stages II-III), a combination of radiation and chemotherapy or radiation and surgery provide the best opportunity to preserve the larynx. Depending on the location and size of the tumor, some patients may undergo radiation or surgery alone.

Surgery

Surgery may involve partial or total removal of the larynx (laryngectomy), portions of the subglottis or supraglottis or removal of just the vocal cords (cordectomy). In some patients, the thyroid gland may also be removed. Partial laryngectomy allows surgeons to preserve speech. In Dharamshila Hospital & Reseach Centre, we perform these procedures and we have expertise in :

Transoral Laser Microsurgery (TLM) uses a flexible, hollow-core fiber to transmit CO2 laser energy, enabling surgeons to reach otherwise inaccessible areas and to perform a 360-degree resection around tumors in ways that were previously not possible.

While advanced techniques are helping preserve normal function, patients who have had their entire larynx or vocal cords removed will lose the ability to speak or breathe normally. There are several options to restore speech:

• A special valve implanted between the trachea and esophagus (food pipe) called voice prosthesis.
• Using a handheld vibrating device (electro larynx) to produce sounds and words
• Intensive speech therapy to learn how to use the esophagus for speaking

All these rehabilitative practices are being successfully done at our centre.